Chapter 31: Common Legal and Ethical Issues

Touhy: Ebersole & Hess' Toward Healthy Aging, 9th Edition

Multiple Choice

1. A nurse suspects that her next-door neighbor, an older woman, is a victim of elder abuse by her daughter. What is the appropriate action for the nurse to do in this situation?

a. Because the neighbor is not a patient, the nurse should not get involved.

b. Visit the neighbor frequently to confirm the suspicions.

c. Complete a confidential report with the adult protective services in the area.

d. Ask the neighbor herself if she is being abused.

ANS: C

The best action is to make a confidential report with the local adult protective agency. Suspected cases should be reported at once to the agency, which will send a trained investigator to determine whether an abusive or imminently dangerous situation exists and will be able to offer safety to the victim and resources to the relatives and family members. In some states with mandatory reporting, failure to report suspicions may result in civil and/or criminal penalties. Also in states with mandatory reporting, the nurse can be held liable for civil and criminal penalties for failure to report suspected cases of abuse. In states without mandatory reporting, it becomes an ethical issue if the nurse is aware of suspected abuse and does not report it. Making a personal investigation will not obtain a safe environment for the neighbor in a timely manner. Asking the neighbor about abuse will not quickly obtain a safe environment or help if needed.

DIF: Cognitive Level: Applying REF: p. 424

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Psychosocial Integrity a. Preparing to draw blood from a client’s arm after asking, “Can I see your arm?” b. Changing the client’s dressing when the client asks, “Will you change this bandage now?” c. Using the client’s monthly allowance to buy a watch when he continuously asks for the time d. Arranging for a benign mole to be removed after the client states, “I don’t like this here.”

2. The nurse is providing care to a client diagnosed with dementia. What option is an example of the appropriate use of implied consent by the nurse?

ANS: B

The correct option demonstrates the client’s willing to have a low-risk procedure completed. The remaining options, especially the one dealing with a surgical procedure, lack the element of client cooperation and/or understanding in the decision-making process.

DIF: Cognitive Level: Applying REF: p. 423

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Psychosocial Integrity a. A homebound client is left alone for days at a time by the caregiver. b. An older client is smacked if he doesn’t eat all of his food. c. A client diagnosed with Alzheimer’s disease is bathed only twice a month. d. A homebound client can only get groceries by agreeing to pay for her neighbor’s groceries, too.

3. Which option is an example of elder exploitation?

ANS: D

In elder mistreatment by exploitation, the abuser takes advantage of the older person for monetary or personal benefit. In this case, the client is being coerced to buy her neighbor’s groceries. Abandonment is defined as the desertion or willful forsaking of an older person. Abuse is any action or inaction harming or endangering the welfare of an older adult. The definition of neglect involves failure to provide adequate care or services for an older adult.

DIF: Cognitive Level: Applying REF: pp. 419–421

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Psychosocial Integrity

4. A frail, elderly widow is admitted to the hospital after sustaining a fall. The client lives alone and has no living relatives. After cognitive testing reveals mild cognitive impairment, the interdisciplinary team on the Acute Care for the Elderly Unit recommends long-term care placement and that a durable power of attorney for health care (DPOA-HC) be established. When the client seems confused over what a DPOA-HC’s responsibilities are, the nurse responds that: a. “A DPOA-HC is a person you name to make health care decisions for you when you can’t make them for yourself.” b. “A DPOA-HC is a person you trust to make financial decisions for you and to manage your money.” c. “A DPOA-HC is a person appointed by the court to make sure you get good care and to manage your affairs.” d. “A DPOA-HC is a person who is appointed by the court to make nursing home placement decisions for your care.”

ANS: A

A person designated by the individual to make health care decisions when the individual is not able is the definition of durable power of attorney for health care. A power of attorney is a person designated by the individual to make financial decisions when the individual is not able to or at his or her request. The definition of a guardian is a person appointed by the court to have care, custody, and control of a disabled person and to manage personal and/or financial affairs. A guardian is able to make many more decisions than just nursing home placement decisions.

DIF: Cognitive Level: Applying REF: pp. 418–419

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Psychosocial Integrity a. “I get so frustrated because my father used to be so competent and now cannot even feed himself.” b. “Mom cannot pay her own bills anymore. We went to the bank and arranged for me to have access to her checking account and help her pay the bills.” c. “My dad wanders at night and I can’t be bothered with him. I mix sleeping pills in his dinner so that he will fall asleep.” d. “Mom asks me to do everything for her, but I think it is better if she keeps on doing as much as she is capable of.”

5. Which of the following statements made by a family caregiver would a nurse consider most indicative of elder abuse?

ANS: C

Option c is an example of elder mistreatment. While wandering is a serious concern, surreptitiously administering sleeping pills is not the best response to this situation and is indicative of elder mistreatment. All of the other situations described are difficult; however, there is no indication of abuse.

DIF: Cognitive Level: Analyzing REF: pp. 419–420

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Psychosocial Integrity a. Financial exploitation b. Psychological abuse c. Caregiver neglect d. Abandonment

6. An older woman tearfully tells a nurse, “I must buy my neighbor all of his groceries, or he will not drive me to the store or the doctor.” This is an example of which type of elder mistreatment?

ANS: A

Financial exploitation involves taking advantage of an older person for monetary gain.

DIF: Cognitive Level: Applying REF: pp. 420–421

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Psychosocial Integrity

Multiple Response

1. When a cognitively impaired, wealthy, white client is noted to have burns on her upper back, her son states that the patient burned herself when attempting to shower. Which statement by a member of the team reflects a need for further education on elder abuse? (Select all that apply.)

a. “She is wealthy; abuse does not happen in people of financial means.” b. “Even if we are not sure, we are legally bound to report our suspicions.” c. “We need to consider that most abusers are either adult children or spouses.” d. “Her cognitive deficiencies put her at risk for elder abuse.” e. “The client is white and race places an important role in who is likely to be abused.”

ANS: A, E

Elder abuse occurs among all races and socioeconomic groups in the United States. All suspected incidences of elder abuse should be reported, even if it is just a suspicion. Most abuse occurs in the home setting, the majority of abusers are spouses or children, and the risk of abuse increases with increased dependency of the elder.

DIF: Cognitive Level: Applying REF: p. 420

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Psychosocial Integrity a. Individuals with cognitive impairment b. Individuals who abused the caregiver earlier in life c. Individuals who live in an institutional setting d. Individuals who are married and living with a spouse e. Men living alone or in a household with family members

2. A nurse is preparing education for a group of older adults and caregivers at a senior center on elder abuse. The nurse is preparing to discuss seniors who are more likely to be abused or neglected. The nurse includes which of the following? (Select all that apply.)

ANS: A, B, C

Individuals who are living alone are more likely to be abused. Women who are living alone or in a household with family members are more likely to be abused than are men.

DIF: Cognitive Level: Remembering REF: p. 420, Box 31-8

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Psychosocial Integrity a. Bruises are in various stages of healing. b. The fracture is inconsistent with the patient’s functional ability. c. Caregiver suffering stress from caring for a functionally-dependent individual. d. Patient is crying. e. Patient has a history of previous wrist fractures.

3. A nurse working in an emergency department is caring for an 89- year-old woman who was brought to the hospital by her daughter for a fracture of the right arm. The woman is wheelchair dependent and lives with her widowed daughter who is the primary caregiver. The daughter states that her mother got up out of the wheelchair unassisted to go to the bathroom and fell. The patient cannot recall the circumstances of the fall. The patient is weeping and cradling her right arm. The patient’s history reveals two previous wrist fractures over the course of the past year. The nurse notes several large ecchymotic areas on the right hand and left arm and on the left side of the body and the back. The ecchymoses are in various stages of healing. Upon assessment, the patient is non-weight-bearing (NWB). The nurse suspects physical abuse based on which of the following findings? (Select all that apply.)

ANS: A, B

Specific signs of physical abuse include unexplained bruising or lacerations or those in unusual areas in various stages of healing, and fractures inconsistent with functional ability. This patient has many bruises in different areas all in various stages of healing, which leads one to believe that they were sustained at different times. The patient is NWB, so the daughter’s statement that she fell while getting out of the wheelchair to go the bathroom does not match the patient’s functional abilities. While there could be caregiver stress in this situation, the scenario does not mention it. While the patient’s crying is concerning, it could be due to many other factors, including pain. A previous history of wrist fractures is concerning as well, but there are many other possible reasons for repeated fractures.

DIF: Cognitive Level: Analyzing REF: p. 424, Box 31-16

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Psychosocial Integrity a. An 85- year-old male with cardiac disease who is taking blood thinners and has multiple bruises on his arms and hands b. An 86- year-old female nursing home resident admitted to the hospital with vaginal bleeding and three large bruises on her inner thigh c. A 77- year-old woman who fell at home and broke her arm after tripping over her cat d. A 73- year-old man with a history of gastric ulcers who is vomiting blood and found to be anemic and has a low BMI e. A 69- year-old man with a history of diabetes who is admitted for diabetic foot ulcers wearing dirty clothing and smells like urine

4. A nurse suspects elder mistreatment in which of the following patients seen in the emergency department? (Select all that apply.)

ANS: B, E

An 86- year-old female nursing home resident admitted to the hospital with vaginal bleeding and three large bruises on her inner thigh has the signs of sexual abuse. The 69- year-old man with a history of diabetes who is admitted for diabetic foot ulcers and is wearing dirty clothing and smells like urine has the signs of neglect (either self or caregiver). The remaining patients do not exhibit the signs of elder mistreatment.

DIF: Cognitive Level: Applying REF: p. 424

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Psychosocial Integrity